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Advanced Neurology Rescue stenting in mechanical thrombectomy

non-RS group (9.7% vs. 14.1%; P = 0.04). Premat et al. associated with increased rates of good procedural and
120
included 352 patients and found no difference in sICH functional outcomes without increased risk of hemorrhage.
rates (OR 0.68 [0.37 – 1.27]; P = 0.23). 121 While further trials are warranted to establish the optimal
Several studies have demonstrated an increased risk rescue strategies and devices, the current evidence may
of IST, stent migration, and subsequent reocclusion in support RS as an alternative intervention in managing
stent-retriever thrombectomy in ICAS-related LVO. 52,122,123 refractory acute LVOs.
Appropriate selection, sizing, deployment of the stent, Acknowledgments
and use of a proper long-term antithrombotic therapy are
important to avoid RS-related complications. None.

5. The role of interdisciplinarity in Funding
neurological emergencies None.

The interplay between neuro-interventionalists and Conflict of interest
neurologists represents a cornerstone of effective
management strategies for neurological emergencies. Thanh N. Nguyen is an Associate Editor of Stroke: Advisory
Assessment of risks and benefits of interventional procedures Board for Brainomix, Aruna Bio, but has no known
should have an interdisciplinary approach with neuro- competing financial interests or personal relationships
interventionalists weighing in potential complications that could have influenced the work reported in this paper.
and technical challenges, whereas neurologists, on the Separately, other authors declared that they have no known
other hand, bring a comprehensive understanding of competing interests.
the patient’s medical history, comorbidities, and the
pathophysiology of neurological disorders. By combining Author contributions
these complementary perspectives, the interdisciplinary Conceptualization: Noor A. Mahmoud, Thanh N. Nguyen
team can make informed decisions tailoring treatment Methodology: Noor A. Mahmoud, Mohamad Abdalkader,
plans to each patient’s unique circumstances. Piers Klein, Thanh N. Nguyen

6. Future research Writing–original draft: Noor A. Mahmoud, Mohamad
Abdalkader, Piers Klein, Thanh N. Nguyen
Despite advancements in our understanding of RS, Writing–review & editing: Noor A. Mahmoud, Sami Al
challenges and limitations remain. First, optimal patient Kasab, Adam de Havenon, Xu Tong, Baixue Jia, Marios
selection for RS is unclear. The current evidence on patient Psychogios, Urs Fischer, Zhongrong Miao, Thanh N.
selection is mainly derived from studies, and generalizing Nguyen
these findings to clinical practice may be difficult. Caution
should be used, particularly in cases where the procedure’s Ethics approval and consent to participate
potential benefits may be uncertain or when patient or Not applicable.
procedural factors place the patient at increased risk.
Second, device options are limited with only a single FDA- Consent for publication
approved device for intracranial stenting and off-label use
of coronary stents in intracranial pathology. Third, it is Not applicable.
unclear how many passes of MT should be attempted before Availability of data
attempting RS. It is also unclear which rescue technique
is optimal between RS, balloon angioplasty, and adjunct Not applicable.
pharmacological therapy. Finally, no randomized trials have References
clearly demonstrated the benefit of RS compared to standard
thrombectomy care in patients with refractory occlusion or 1. Feigin VL, Owolabi MO, World Stroke Organization-Lancet
ICAS-LVO. Prospective studies and randomized controlled Neurology Commission Stroke Collaboration G. Pragmatic
trials to address RS and angioplasty are ongoing (ANGEL- solutions to reduce the global burden of stroke: A world
REBOOT, RESCUE ICAS, ICARUS, and PISTAR). 66,124,125 stroke organization-lancet neurology commission. Lancet
Neurol. 2023;22:1160-1206.
7. Conclusion doi: 10.1016/S1474-4422(23)00277-6

RS is considered a rescue therapy when initial MT attempts 2. Saver JL, Goyal M, Bonafe A, et al. Stent-retriever
fail to achieve successful recanalization. RS appears to be thrombectomy after intravenous t-PA vs. t-PA alone in

Volume 3 Issue 3 (2024) 7 doi: 10.36922/an.3950